A paper in The Lancet (10 October 2015) looks at the quality of cardiovascular health care in China. Below is the citation and summary. I also reproduce here the authors’ succinct description of the broader concept of ‘quality of care’:

‘In a health system with high quality of care, patients get the care they need at the right time, without having to undergo unnecessary or inappropriate treatments. High-quality care not only provides patients with the best opportunity to achieve the outcomes they seek, but also avoids inefficiency and waste. Countries with few resources especially need to focus on what care is best and how it is provided, and strengthen health-care delivery systems to produce high-level performance as efficiently as possible.’

As a personal comment, I find this a pragmatic definition, and would be interested to know how embedded this approach is in different countries. I suspect that many if not most governments turn a blind eye to, or actively support, treatments that have not been demonstrated to be effective. There was recent controvery in the UK, for example, when it emerged that the UK National Health Service spends over 70 million US dollars a year on homeopathy, despite the lack of evidence that it works any better than placebo…

The current Lancet review article on cardiovascular care in China points out that around 290 million people in China are affected by cardiovascular disease. The quality of care they receive (and, even more important, their smoking behaviour) will have a massive impact not only on China, but on the global health target for NCDs: “3.4. By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being”

‘China has an immediate need to address the rapidly growing population with cardiovascular disease events and the increasing number of people living with this illness. Despite progress in increasing access to services, China faces the dual challenge of addressing gaps in quality of care and producing more evidence to support clinical practice. In this Review, we address opportunities to strengthen performance measurement, programmes to improve quality of care, and national capacity to produce high-impact knowledge for clinical practice. Moreover, we propose recommendations, with implications for other diseases, for how China can immediately make use of its Hospital Quality-Monitoring System and other existing national platforms to assess and improve performance of medical care, and to generate new knowledge to inform clinical decisions and national policies.’

Interestingly, the authors do not suggest a role for traditional Chinese medicine. It would be interesting to know more about health professionals’ and health policymakers’ attitudes to Chinese traditional medicine, which continues to be a huge industry in China, presumably much of it funded by the Chinese public health system.

Best wishes, Neil

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